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Dr Alalade & Dr Klemenz Good

Inspection Summary


Overall summary & rating

Good

Updated 5 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection on 16 February 2017, where the practice was rated as requires improvement overall. Before this the practice had been in special measures following an inspection in May 2016. The practice was taken out of special measures, but there were still areas which needed improvement. These included maintaining accurate and complete records of patient care and treatment; reviewing arrangements for identifying patients who were also carers; reviewing arrangements related to not having a defibrillator on site; and reviewing arrangements for reporting significant events to external bodies.

The full comprehensive report on the February 2017 inspection can be found by selecting the ‘all reports’ link for Dr Lawson and Dr Alalade on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 17 October 2017 to confirm that the practice had met the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 16 February 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection on 16 February 2017.

Overall the practice is now rated as good.

Our key findings were as follows:

Improvements had been made and the requirement to maintain an accurate and complete record in respect of each patient including care plans had been met. Care plans were shared with the patient and other relevant health professionals. Also:

  • The practice had reviewed its risk assessment related to having a defibrillator on site and had purchased one.

  • The practice was more proactive in identifying carers to provide appropriate support.

  • The practice was working more closely with the patient participation group and involving them in the running of the practice.

  • The practice had started to use a reporting system for significant events which enabled them to report to external bodies and there was evidence on acting fully on safety alerts.

However, there were also areas of practice where the provider needs to continue to make improvements.

The provider should:

  • Review arrangements for sharing information about vulnerable patients, particularly those with a mental health condition who moved to another area or who do not attend appointments.

  • Continue with arrangements to identify patients who are also carers to improve numbers.

  • Review the process for ensuring that blood tests have been completed and the results have been received, prior to medicines being prescribed.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 5 December 2017

Effective

Good

Updated 5 December 2017

The provider is now rated as good for providing effective services.

  • There was a recall system in place for patients who did not attend for their health reviews and exception reporting had improved across all areas in the Quality and Outcomes Framework. In particular, all patients with diabetes had received a blood test to monitor their blood sugars level, with no exceptions. This was the case for all diabetes indicators.

  • Templates available on the computer systems were used, this enabled information to be captured in a systematic manner to inform care plans. We reviewed a sample of care plans for patients with long term conditions. We found that these contained appropriate information to managed conditions and these had been shared with the patient and other health professionals as needed.

Caring

Good

Updated 5 December 2017

The provider is now rated as good for providing caring services.

  • Patients were asked when registering at the practice whether they were a carer. GPs also used appointments to ask patients if they were carers. Written information was available to direct carers to the various avenues of support available to them.

Responsive

Good

Updated 5 December 2017

The provider is now rated as good for providing responsive services.

  • We reviewed records which showed that longer appointments were available to meet patients’ needs. For example, for patients with long term conditions appointments were available for up to 50 minutes dependant on what needed to be covered in their review.

  • In addition the practice had introduced a system where patients with asthma were offered a spirometry check four to six weeks after having a chest infection. Any patient who requested an appointment for a mental health problem was put into the same day walk-in doctor triage appointments and when able were given a double appointment of 20 minutes.

Well-led

Good

Updated 5 December 2017

The provider is now rated as good for providing well led services.

  • The business plan had been reviewed and updated to include systems which had been put into place since our previous inspection which underpinned the governance structure.

  • Improvements had been made to systems for handling letters from the out of hours service and A&E; and results of blood tests. There were now clear guidelines for staff on who was responsible for reviewing this correspondence and ensuring action was taken.

  • Systems for monitoring patients using the Quality and Outcomes framework had improved. Nominated members of staff were responsible for ensuring data was captured accurately and attempts were made to encourage patients to attend for reviews prior to exception reporting.

  • The practice had started to use a clinical commissioning group (CCG) system where significant events and complaints were shared. They received a newsletter every quarter which informed them of themes and trends in the CCG area, as well as in the practice. This enabled the practice to monitor actions they had taken and also to be aware of other areas which might require attention.

  • We met with a member of the Patient Participation Group who said they now were more involved in the running of the practice and received information on how themes and trends from significant events and complaints were acted upon.

However although areas of governance had improved there were some systems that needed to be fully embedded in the day to day running of the practice; such as

  • for the consistent management of high risk medicines which needed blood test to ensure the relevant dose was given.

  • for improving sharing of information for vulnerable patients needed to be reviewed to improve the support of patients when the patient moved to another healthcare service.

Checks on specific services

People with long term conditions

Good

Updated 5 December 2017

The provider had resolved the concerns for effective, caring, responsive and well led identified at our inspection on 16 February 2017 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Families, children and young people

Good

Updated 5 December 2017

The provider had resolved the concerns for effective, caring, responsive and well led identified at our inspection on 16 February 2017 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Older people

Good

Updated 5 December 2017

The provider had resolved the concerns for effective, caring, responsive and well led identified at our inspection on 16 February 2017 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

Working age people (including those recently retired and students)

Good

Updated 5 December 2017

The provider had resolved the concerns for effective, caring, responsive and well led identified at our inspection on 16 February 2017 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

People experiencing poor mental health (including people with dementia)

Good

Updated 5 December 2017

The provider had resolved the concerns for effective, caring, responsive and well led identified at our inspection on 16 February 2017 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

People whose circumstances may make them vulnerable

Good

Updated 5 December 2017

The provider had resolved the concerns for effective, caring, responsive and well led identified at our inspection on 16 February 2017 which applied to everyone using this practice, including this population group. The population group ratings have been updated to reflect this.

However:

Arrangements for sharing information about vulnerable patients, particularly those with a mental health condition who move to another area or who do not attend appointments were not fully effective.